Max Institute of Cancer care (MICC) offers comprehensive state of the art services for early diagnosis, staging, treatment and hospital-based care of Disease management group (DMG) –Gynaecology Oncology. An individualised treatment plan is made for each patient by a specialist multidisciplinary team of medical oncologists, radiation oncologists, surgeons, histopathologists, molecular pathologists, gastroenterologists, interventional radiologists, nuclear medicine, dietitians, physiotherapists and geneticist. There is are a constant cross chat between the various specialities at the Respective DMG Tumour Board meeting, The main concept behind the DMGs at MICC is to make the best skills available to our patients. Site-specific oncology allows the clinicians involved in patients care to focus only on certain cancers at which they become world experts. Meetings are held once a week to discuss all patients diagnosed with DMG specific cancer and arrive at the best possible management for the patient. The Surgical Medical and Radiation specialists of the respective DMG along with the Pathologists, Radiologist and Molecular Oncologists attend these meetings. All patients seen between these meetings are, however, discussed in the common tumour Boards held once a week.

Max Institute of Cancer care (MICC) offers comprehensive state of the art services for early diagnosis, staging, treatment and hospital-based care of Disease management group (DMG) –Gynaecology Oncology. An individualised treatment plan is made for each patient by a specialist multidisciplinary team of medical oncologists, radiation oncologists, surgeons, histopathologists, molecular pathologists, gastroenterologists, interventional radiologists, nuclear medicine, dietitians, physiotherapists and geneticist. There is are a constant cross chat between the various specialities at the Respective DMG Tumour Board meeting, The main concept behind the DMGs at MICC is to make the best skills available to our patients. Site-specific oncology allows the clinicians involved in patients care to focus only on certain cancers at which they become world experts. Meetings are held once a week to discuss all patients diagnosed with DMG specific cancer and arrive at the best possible management for the patient. The Surgical Medical and Radiation specialists of the respective DMG along with the Pathologists, Radiologist and Molecular Oncologists attend these meetings. All patients seen between these meetings are, however, discussed in the common tumour Boards held once a week.

Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.

Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.

Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Factors that can increase your risk of ovarian cancer include:

Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.

Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer.
Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer.

Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease.

Estrogen hormone replacement therapy, especially with long-term use and in large doses.

Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.

The type of cancer that begins in the ovaries (female reproductive glands) is known as Ovarian Cancer. Any abnormal growth of a tissue in the ovaries leads to ovarian cancer and because it starts silently, this disease is often diagnosed in its later stages. Though ovarian cancer can occur at any age, ovarian cancer specialists in India state that older women who are above 60 years of age are at a higher risk.

WHAT ARE THE SYMPTOMS OF OVARIAN CANCER?

In the early stages, ovarian cancer has little or no symptoms. Ovarian cancer symptoms are often overlooked as they are similar to other illnesses that are common and can be treated with over-the-counter (OTC) medicines. However, if ovarian cancer symptoms repeatedly come and go, getting professional help should be considered. The ovarian cancer symptoms include:

Pressure, pain and bloating in the abdominal region

Difficulty eating and abnormal fullness after every meal

Increased urination

Abnormal pain during sex

Pelvic or abdominal pain

Severe back pain

Changes in the menstrual cycle and constipation

Heartburn and upset stomach

Fatigue

Though these symptoms may occur because of any other condition in the body, if someone has had one or more of these for a significant period, it is advisable to consult a cancer specialist. These symptoms might not be severe in the initial stage but as the tumour grows and the cancer spreads outside of the ovaries, the pain can become severe. Like any other cancer, ovarian cancer, if detected in later stages is hard to treat.

CAUSES OF OVARIAN CANCER

The division and multiplication of cells in an unregulated way in the ovaries causes ovarian cancer. Though, the root cause behind this cancer type is still unknown, there are many risk factors that increase the chance of developing this disease.

Family history – If someone in the family has had ovarian or breast cancer in the past, the risk increases

WHAT ARE THE TYPES OF OVARIAN CANCER?

Differentiated by the kind and type of cells in which cancer starts, there are three main types

Epithelial Ovarian Tumours – Epithelial Tumours develop from the cells that cover the surface of the fallopian tube or the ovary.

Germ cell Ovarian Tumours – These are derived from the ova or egg producing cells and most of them are not even cancerous.

Cord-stromal Cell Ovarian Tumours – Termed as a rare class of tumours, these are derived from the connective tissue that produce female hormones and hold the ovary together.

WHAT ARE THE TREATMENT OPTIONS FOR OVARIAN CANCER?

Once the patient is through with the several diagnostic tests, the specialist may recommend one or more ovarian cancer treatment options depending on the stage. The main ovarian cancer treatment options include:

Surgery – Most ovarian cancers can be treated by surgery. The extent of surgery required usually depends on how far cancer has spread and also on the general health of the patient. In many cases, the disease is treatable even without the removal of the uterus and ovaries. The main goal of the surgery is to remove the cancer completely from the body.

Chemotherapy – When the cancer has metastasized in other parts of the body, the patient must undergo Chemotherapy. It is a systematic treatment in which the drugs are given in a way that they reach all parts of the body. Most of the time, the drugs are either injected into a vein, through a thin tube into the abdominal cavity or by mouth.

Hormone Therapy – Hormone-blocking drugs are used to fight cancer in Hormone Therapy. This treatment option is helpful in treating ovarian stromal tumours.

Targeted Therapy – Relatively a new treatment type, targeted therapy uses drugs that directly attack the cancer cells while causing less harm to the normal cells.

Radiation Therapy – The use of high-energy particles or X-rays to kill cancer cells is known as Radiation Therapy. However, Radiation Therapy is employed parallelly with chemotherapy or when patient does not respond to other treatment options.

At Max Hospital, we have the best oncologists in India who specializes in treating ovarian cancer with surgery, hormone therapy, targeted therapy, radiation therapy and chemotherapy.

LIFE AFTER OVARIAN CANCER TREATMENT

Completing ovarian cancer treatment is no doubt stressful. However, in many cases, the patient starts worrying about the recurrence of the cancer and profoundly notices every small pain in the body. Furthermore, it takes a few months to settle with the idea of completing the treatment and start living a normal life like before.

The leading ovarian cancer treatment hospital in India has listed a few things that can help every survivor recover fast and lead a better life –

Save energy and use it on things that are important

Don’t push your body too hard to finish any task

Seek help from friends and family members

Incorporate a healthy lifestyle

Keep away from stress and think of ways in which you can reduce it

Create the perfect balance between being active and resting

Be vocal about how you feel to the people around you

Try not to rush things and set a goal for your life

Once the necessary treatment is completed, it is vital to visit your treating doctor for all the follow-up appointments. During these visits, the doctor will watch your progress closely by performing various exams and asking you several questions. Remember, every treatment has its own set of side-effects that last for a few weeks to months and may vary for everyone. Give your doctor a clear idea about your condition and side-effects that you may be experiencing.

Endometrial cancer is also known as uterine cancer. This cancer starts in the layer of cells that form in the lining of the uterus. There are different types of uterine cancer, one of the most common types starts in the endometrium, and this type is also called endometrial cancer, the ones that occur in the muscle or supporting stromal tissue of uterine wall, called uterine sarcomas which are relatively rare.

Signs and symptoms of endometrial cancer may include:

Vaginal bleeding after menopause

Bleeding between periods

An abnormal, watery or blood-tinged discharge from your vagina

Pelvic pain

It is detected at an early stage as it constantly produces unusual vaginal bleeding, which triggers the women to visit their doctors. If in case the endometrial cancer is discovered early, then removing the uterus surgically cures this type of cancer.

Risk factors

Factors that increase the risk of endometrial cancer include:

Older age

Hyperestrogenic states. A disease or condition that increases the amount of estrogen, but not the level of progesterone, in your body can increase your risk of endometrial cancer. Examples include irregular ovulation patterns, such as those that can occur in women with polycystic ovary syndrome, obesity and diabetes. Taking hormones after menopause that contain estrogen but not progesterone also increases the risk of endometrial cancer.

Early menstruation and late menopause. This increase the duration of exposure of endometrium to estrogen and thereby increasing the chances of endometrial cancer

Nulliparity. Women who have never been pregnant have a higher risk of endometrial cancer than do women who have had at least one pregnancy.

Obesity Being obese increases one’s risk of endometrial cancer. This happens because of peripheral conversion of hormones in the adipose tissue.

Hormone therapy for breast cancer. Women with breast cancer who take the hormone therapy drug tamoxifen have an increased risk of developing endometrial cancer

An inherited colon cancer syndrome. Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of colon cancer and other cancers, especially endometrial cancer. HNPCC occurs because of a gene mutation passed from parents to children. The doctor may ask for cancer test s that includes a pelvic exam, imaging tests, and a biopsy. One of the most common treatments is a hysterectomy; it is a procedure wherein the uterus is removed, if enquired the surgery also removes the ovaries and fallopian tubes and addressing the draining lymph nodes by either sentinel lymph node excision or complete lymphadenectomy depending on a case-to-case scenario. Post-surgery the need for adjuvant radiation or chemotherapy can be discussed for individual cases.

The neck of the womb or the uterus is known as the cervix. It is the narrow portion where the body of the uterus joins the vagina. Cancer is a disease caused by the abnormal growth and division of cells. Cervical cancer begins in the cells on the surface of the cervix. Cancer cervix is the third most common cancer in Indian women. Approximately 97 thousand women are diagnosed with cervical cancer and 60 thousand women die of cervical cancer in India every year.

Two vaccines—bivalent and quadrivalent are available for preventing HPV infection. They should ideally be used before sexual exposure. They can be given between ages 9-26 years. This vaccine does not treat existing HPV infection. Nonavalent HPV vaccines are available in the U.S. which give protection against 9 HPV strains.

Pap Smear and HPV DNA are screening tests for cancer cervix. Pap smear can detect cancerous cells or changes in the cells of the cervix that may lead to cancer. While examination in the outpatient clinic cells from the cervix are collected using a wooden spatula and brush. These cells are either spread on a slide (conventional Pap smear) or sent in a liquid (Liquid based cytology/ Liquid Pap) to the laboratory.

Pap tests should begin after age 21 years and three years after initiation of sexual activity. Women younger than 30 years should have a Pap test every 2 years. HPV infection is very common in younger women, but it usually goes away on its own. A positive HPV test result in a young woman is most likely become negative without any treatment. Hence, routine HPV testing in young women less than 30 years is not recommended. Women aged 30 years and older should have a Pap test every 3 years after three normal annual Pap test results in a row. If the uterus has been removed, need of doing a Pap smear must be discussed with a gynecologist. Pap smear results may not always be accurate. The results if indicate abnormality, should not trigger panic button—the opinion of a gynecologist must be sought immediately. For women 30 years or older, cancer-causing types of HPV can be detected at the same time the Pap test is performed using liquid based method. If the results of both HPV test and Pap test are normal, no further testing is required for another 3 years.

Confirmatory diagnosis of cervical cancer is obtained by performing a biopsy from cervix under colposcopic guidance. The biopsy can be obtained from the abnormal appearing area or growth on the cervix using a punch forceps or by cutting a conical piece of the cervix using knife (conization) or by using an electrical wire known as loop electro-excision procedure (LEEP) of the cervix.

A team of Gynae Oncologists, Radiation Oncologists and Medical Oncologists manages cervical Cancer. The woman is assessed and after confirming the diagnosis of cervical cancer, the case is discussed in the Tumor Board. Based on international evidence based guidelines, a plan of action is formulated. The options of management offered are surgery, radiotherapy, chemotherapy or a combination of all the above modalities. The treatment decided depends on the clinical staging of cancer. Surgery to remove cervical cancer may be an option when the cancer is confined to the cervix.

CERVICAL CANCER OVERVIEW

Cervical cancer is the third most common type of cancer affecting the women. This type of cancer starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. This cancer develops very slowly and begins as a precancerous condition called dysplasia. Almost all cervical cancers are caused by HPV (human papilloma virus), which is a common virus that spreads through sexual intercourse. All women should begin cervical cancer screening when they are 21 years old. It is the easiest female cancer to prevent with regular Pap smears and follow-up. Screening should be done every 3 years in women with no history of abnormal Pap smear. Depending on the stage of the disease, a cervical cancer treatment hospital in India can perform surgery, radiotherapy and chemotherapy.

CERVICAL CANCER SIGNS AND SYMPTOMS

In its initial stage, there are no symptoms of cervical cancer. However, its symptoms include:

Abnormal vaginal bleeding between periods and after intercourse

Post-menopausal bleeding, if you are not on HRT or have stopped it for six weeks

Continuous vaginal discharge

Unusual and/or unpleasant vaginal discharge

Back pain

Fatigue

Leg pain

Pelvic pain

Single swollen leg

Weight loss

Heavier periods that usual

CAUSES OF CERVICAL CANCER

This type of cancer starts in the cells on the surface of the cervix. Its major causes are:

Not getting the HPV vaccine

Poor economic status

Weakened immune system

Unhealthy sexual intercourse

Multiple sexual partners

Intercourse with people involved in high-risk sexual activities

TREATMENT

The treatment of cervical cancer generally depends on various factors – cancer stage, size and shape of the tumor, woman's age and general health. In earlier days, cervical cancer was being cured by the removal of cancerous tissues. However, nowadays surgeries have undergone heavy advancements. Different cervical cancer treatment options are:

Vulval cancer is also known as vulvar cancer. The vulva relates to the woman’s external genitals that include the soft tissue which surrounds the vagina, the clitoris (a structure about the size of a pea located at the top of a woman's vulva, above the urethral opening) and the Bartholin’s glands, that are two small glands on the each side of the vagina that secrete a fluid to enhance lubrication. It frequently begins as vulvar intraepithelial neoplasia precancerous change), which appears when healthy skin cells around the vulva undergo unusual changes. If not treated timely, the abnormal cells can turn into cancer. Usually, early-stage cancer may be not cause any signs, but women may present with persistent vulval itching, painful intercourse and urination, a lump or swelling in the vulva, bleeding or discharge from vulvar swelling, reduced pigmentation of the skin or dark patches on the skin of the vulva.

All these symptoms may be produced by other common conditions, such as infection, but if in case you notice any of these; you should see your doctor. It is unexpected that the symptoms are caused by a serious problem but it is very important to get it checked, non- cancerous conditions can be intolerable and so much better when it gets treated.

A team of Gynae Oncologists, Radiation Oncologists and Medical Oncologists manages Vulvar Cancer. The woman is assessed and after confirming the diagnosis of cancer, the case is discussed in the Tumor Board. Based on international evidence based guidelines, a plan of action is formulated. The options of management offered are surgery, radiotherapy, chemotherapy or a combination of all the above modalities. The treatment decided depends on the clinical staging of cancer. Surgery to remove vulva along with lymph nodes in the inguinal and/or pelvic regionmay be an option when the cancer is confined to the Vulva.

Gynecologic cancer is distinctive, and it has different signs and symptoms, with non-similar risk factors (things that can increase the patient’s chance of getting a disease), and different prevention strategies. Here are the subsequent risk factors for different kinds of gynecologic cancers. Each cancer having its own general risk factors and can affect women in various ways. Here are the risk factors such as:

Post-menopausal (over age 50)

Endometrial hyperplasia – it is a condition where the cells of the endometrium are not usual

Cervical dysplasia – It is a condition where the cervical cells are uncommon

Obesity

Diabetes

High blood sugar

Other cancers such as colon, rectal, breast

Early age of first menstruation

Women who have never been pregnant

Hormone-related issues

Family history of breast or ovarian cancer/Genetic Syndrome

Gynecology Oncology is an order that focuses on the treatment of cancers of a gynecologic nature. A gynecological oncologist treats all these diseases; they have an extensive training in the diagnosis of these diseases. The Gynecologic oncologist is a specialist that specializes in diagnosing and treating cancers, which are located on a female reproductive organ. The gynecologic oncologist performs as the captain of female’s gynecologic cancer tram, it is very important to consult gynecologist prior the treatment is started so, that a better treatment process is selected for the patient.

The state-of-the-art Gynaecologic Oncology DMG (Disease Management Group) provides customised treatment to every patient after discussion in great depth. It has been appreciated all over and has won awards at national level. We also regularly discuss our patients at the National Cancer Grid Virtual Tumour Boards.

Genetic and molecular information is routinely incorporated in order to provide personalised and precise treatment

We provide a strong backup of on-site ICU as well as other speciality services like cardiology, nephrology, neurology, endocrinology, gastro-enterology and others.

We provide treatment for all kinds of gynaecologic cancer like ovarian cancer, endometrial cancers, cervical cancer, vulvar and vaginal cancers, sarcomas and others.

Colposcopy , LEEP, Conization, laser for various pre-invasive lesions of the genital tract

Medical Oncology

HIPEC

Dose-dense Chemotherapy

Intra-peritoneal Chemotherapy

Immunotherapy

Targeted therapy

Molecular therapy

Genetic Tumor boards and specific management

Cooling caps during chemotherapy to prevent hair loss

Radiation Oncology

We are one of the most advanced centers in India providing individualized, safe and high quality radiation therapy – both external and internal radiotherapy.

We offer high-end treatments like IMRT, IGRT for these cancers with facilities like cone beam CT and ExacTrac. These treatments enables us to deliver radiation precisely to the target areas while reducing dose to the nearby normal structures.

At Max, we have a dedicated OT and brachytherapy room for internal radiation which is an integral part of treatment of these cancers.

We routinely do intracavitary brachytherapy and interstitial brachytherapy (for advanced cancers) in large numbers.

Cancer imaging services by the radiology department

Our aim is to establish our techniques so that they work as prognostic and predictive biomarkers

Latest technology and protocols are followed for the imaging of patients which enables more detailed and informative reporting.

Senior radiologists with expertise in women`s oncological imaging provide high quality reports which has shown consistently to improve patient results.

Armamentarium of high end state-of-the-art imaging equipment

3 tesla MRI with wide bore and 16-channel coil for high resolution and Dynamic imaging

High resolution ultrasound equipment with 3D and 4D applications and special settings for intervention procedures